Individual
DR. MICHAEL DREW LASALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 S ORANGE AVE, 228, LIVINGSTON, NJ 07039-5817
(973) 322-0133
(973) 322-0134
Mailing address
200 S ORANGE AVE, 228, LIVINGSTON, NJ 07039-5817
(973) 322-0133
(973) 322-0134
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
25MA05925200
NJ
208800000X
Urology Physician
Primary
25MA05925200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223600796
AETNA,HORIZON
NJ
01
—
P1076991
OXFORD
NJ
Enumeration date
10/02/2006
Last updated
05/01/2024
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